Increasing awareness of the dangers and costs of healthcare-associated infections has led to the rapid growth of campaigns that seek to “stamp out infections” or “target zero.”
“In every meeting I went to, I heard something new,” said Denise Cardo, director of the Centers for Disease Control and Prevention's healthcare quality promotion division. “My concern was not that there were so many different terms for eradication. My concern was, what do they mean? How do we get there?”
In a new white paper published in the American Journal of Infection Control and the journal Infection Control & Hospital Epidemiology, a coalition of representatives from the CDC and several major infection prevention and public health groups laid out a four-pillar framework that they say will move the healthcare system toward the ultimate goal—elimination of healthcare-associated infections.
“I think the biggest difference in this paper is that we embraced elimination but also defined it as a continuous process of interventions and quality improvement that move us toward eradication,” said Neil Fishman, director of the department of healthcare epidemiology and infection control at the University of Pennsylvania Health System, Philadelphia, president of the Society for Healthcare Epidemiology of America, and a co-author of the paper.
The paper, which the authors described as a “call to action,” advocates the adoption of several steps including implementation of evidence-based practices; integration of incentives such as increased payment for successful prevention; creation of a more effective system to address knowledge gaps; and data collection and measurement.
“It's not a new concept,” Cardo said. “What is new is that we were all working together, defining the framework we need to move in that direction.”
In addition to the CDC and the Society for Healthcare Epidemiology of America, other participating groups included the Association for Professionals in Infection Control and Epidemiology and the Infectious Diseases Society of America.
The paper's emphasis on addressing gaps in knowledge is critical, Fishman said. For instance, he said, the estimates for preventable central line-associated bloodstream infections range from 16% to more than 80%. And although recent prevention campaigns such as On the Cusp: Stop BSI, an initiative led by patient-safety expert Peter Pronovost, have demonstrated real success in significantly lowering rates of central-line infections, they are mostly limited to patients in intensive-care units.
The data “has highlighted the potential to achieve our desired goal, but it really has not defined the goal for all of the patients who we care for,” Fishman said.
Cardo said she hopes the framework will be used to inform policymaking decisions and spur collaboration.
“Policy changes are coming with or without the paper, but what I hope is clear is that we should not do this work in silos,” she said.
